Healthcare Provider Details
I. General information
NPI: 1861059412
Provider Name (Legal Business Name): PEAK EDUCATIONAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 05/20/2019
Last Update Date: 05/26/2022
Certification Date: 10/04/2021
Deactivation Date:
Reactivation Date:
III. Provider practice location address
2825 S ANKENY BLVD STE 111
ANKENY IA
50023-9417
US
IV. Provider business mailing address
2825 S ANKENY BLVD STE 111
ANKENY IA
50023-9417
US
V. Phone/Fax
- Phone: 515-598-7200
- Fax: 515-598-7323
- Phone: 515-598-7200
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 103K00000X |
| Taxonomy | Behavior Analyst |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
AUTUMN
N
MCKEEL
Title or Position: OWNER
Credential: PH. D., BCBA-D
Phone: 515-598-7200